What Does Medicare Cover

TreatmentApril 20, 2023

As Americans age, the cost of healthcare becomes increasingly important. For those over 65, Medicare is an important source of healthcare coverage, however, many people are confused about what it exactly is covered by it. Here is a breakdown of what is covered by Medicare.

Medicare can be broken down into different parts, each covering different services:

– Part A: Hospital Insurance

– Part B: Medical Insurance

– Part C: Medicare Advantage Plans

– Part D: Prescription Drug Coverage

Part A: Hospital Insurance

Part A covers inpatient hospital care, hospice care, skilled nursing facility care, and home health care. Specifically, Part A covers the following:

– Inpatient care in a hospital

– Inpatient care in a skilled nursing facility

– Hospice care

– Home health care

MH Illustration/ iStock | Medicare was signed into law by President Lyndon B. Johnson

Part B: Medical Insurance

Part B covers services and supplies that are medically necessary to treat a disease or condition. Specifically, Part B covers the following:

– Doctor visits

– Preventative services

– Medical equipment and supplies

– Outpatient care

– Mental health services

– Ambulance services

– Durable medical equipment

– Clinical research

– Second opinions before surgery

Part C: Medicare Advantage Plans

Private insurance companies approved by Medicare offer Medicare Advantage plans. These plans offer all the benefits of Parts A and B and often offer additional benefits such as dental, vision, and hearing coverage. Medicare Advantage plans may also offer prescription drug coverage.

Part D: Prescription Drug Coverage

Part D is optional prescription drug coverage. It is offered by private insurance companies approved by Medicare. You can sign up for Part D if you have Parts A and/or B. Enrolling in Part D as soon as you are eligible is important, as you may be subject to a penalty if you do not.

Helen Dickinson/ Getty Images | Medicare is a federal social insurance program and was introduced in 1965

What is Not Covered by Medicare?

While Medicare covers a wide range of services, there are some things that it does not cover. Here are some of the items and services that Medicare does not cover:

Long-Term Care

Medicare does not cover most long-term care services, such as assisted living facilities, nursing homes, and home health aides. These services are typically paid for out-of-pocket or through Medicaid.

Dental, Vision, and Hearing

Medicare does not cover routine dental, vision, or hearing services. Some Medicare Advantage plans may offer these services but are not covered under Original Medicare.

Personal Care Items

Medicare does not cover personal care items, such as adult diapers, unless medically necessary.

Adriana Bellet/ NBC News | More than 55 million Americans rely on Medicare for their health care coverage

Conclusion

Understanding what is covered by Medicare is an important part of planning for healthcare costs in retirement. Medicare is broken down into different parts, each covering different services. Part A covers inpatient hospital care, hospice care, skilled nursing facility care, and home health care.

Part B covers services and supplies that are medically necessary to treat a disease or condition. Part C, also known as Medicare Advantage, is offered by private insurance companies and offers additional benefits. Part D is optional prescription drug coverage. It is important to note that several services are not covered by Medicare, including long-term care, dental care, and cosmetic surgery.